Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5105 | SC |
NPI | 1013301738 |
---|---|
Provider Name | Harold Woodliff Sanford JR. |
First Address | Columbia, SC 29201-3837 |
Second Address | Columbia, SC 29201-3837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2015 |
Last Update Date | 21/05/2015 |